Research results: Depression in children with learning disabilities

Dr. John Maag, an expert on depression in kids with learning disabilities, discusses research on the topic.

By John W. Maag, Ph.D.

Depression can affect anyone, including children. It is one of the few conditions whose symptoms, such as feeling sad, have been experienced by most of us at some time in our lives. Who cannot admit to feeling "bummed out" in response to certain situations? Yet the clinical "syndrome" (a group of symptoms experienced together) of depression represents a disorder that can have a negative impact on almost all aspects of an individual's life.

Children with learning disabilities (LD), in particular, have been the focus of almost 30 years of research on depression. When early studies were conducted in the 1970s, there were three reasons why children with LD were believed to be at greater risk for depression than children without LD:

Children with LD often experienced low self-esteem, which is a symptom of depression.

Children who were depressed tended to score lower on academic achievement tests, which is a defining characteristic of LD.

Both children with LD and those who were depressed were believed to have some type of neurological disturbance.

Subsequently, researchers realized that low self-esteem and academic underachievement were conditions that affected many children, not just those who were depressed or those with LD. Also, it has been very difficult to pinpoint specific neurological causes for both depression and LD. Therefore, more accurate information was needed about the extent and impact of depression on children with LD.

Because public schools are mandated by law to provide services to children with LD, school was the logical place to begin looking at depression in these children. I began studying depression in children with LD in 1986. Through my research, and that of others during the 1980s and 1990s, it appeared that about 5% to 20% of children with LD experienced symptoms of depression. These figures were much higher than the acknowledged 2% rate for children without LD. But what the research didn't tell us was whether children with LD experienced clinical depression at a rate higher than that experienced by the general population.

To answer this question, Bob Reid, my colleague at the University of Nebraska-Lincoln, and I collected every study conducted on depression in children with LD since 1977 when it became a federal category of disability. We reviewed 18 studies — all of which administered a "depression inventory" to children in the school setting. (Three of these studies were omitted because they didn't meet important criteria for statistical analysis.) We reached three major conclusions from our review and analysis:

Children with LD had statistically higher depression inventory scores than their non-disabled peers, but the magnitude of the difference between the two groups was not great.

Children with LD were at no greater risk for experiencing severe depression than their non-disabled peers.

Factors other than having an LD, such as gender, age, and ethnicity may contribute just as much, if not more, to a child experiencing depression. (We know, for example, that far fewer females have LD than males.)

Unanswered questions about depression and children with learning disabilities

There are several areas in which we simply do not know the answer when it comes to depression and children with LD:

We do not know if children with LD experience clinical depression in greater numbers than their non-disabled peers. The reason that these data haven't been collected is because a depressive disorder can only be diagnosed by a psychiatrist or psychologist after conducting a thorough clinical interview. The time involved and the number of clinicians required to administer clinical interviews to a large random sample of children with and without LD would be astronomical.

We do not currently know what causes depression. Theories abound, but none are conclusive. In all likelihood, depression probably involves hereditary, neurological, and environmental components.

We don't know exactly how accurately depression rating scales can predict whether a child with a high score would receive a clinical diagnosis of depression.

To explain the third point further, several commonly used paper-and-pencil rating scales or "depression inventories" are an important element of a clinician's diagnosis of depression. Most of these inventories are of the self-report variety. That means that a child is given a rating scale, reads the questions, and marks the one(s) that most accurately describes how he or she is feeling. Here is a sample item:

0 I am sad once in a while.
1 I am sad many times.
2 I am sad all the time.

After reading each item, the child circles the number (0, 1, or 2) next to the statement that best describes how he is feeling.

However, a diagnosis of depression should never be made solely on the basis of a score from a rating scale for at least two reasons:

In some cases, there are no significant differences between the scores of children who are and are not depressed.

There is a tremendous difference in scores even among children who have been clinically diagnosed as depressed.

In spite of this, these self-report rating scales have been the main way that information on depression among children with LD has been gathered. This fact raises further questions about the validity of the research to date on whether children with LD are more likely to be depressed than their non-disabled peers. Parents should view critically, if not skeptically, most of the studies examining depression among children with LD.

It's also important to note that, although research is inconclusive on several aspects of depression among children with LD, the news media often paint a very different picture. Parents may assume from what they read, hear, or see in the media that there is an indisputable connection between LD and higher rates of depression in children. As we know, news media are often interested in sensationalizing problems; they look for quick answers and rarely cover stories that contradict initial pronouncements. This makes it very important for parents to be informed consumers and sift through the nonsense and hype that media can report on the problem.

Watch for symptoms of depression at home and at school

My colleagues and I have advocated for years for parents who have children with LD to become familiar with the symptoms of depression so that any problems might be identified early on. Depression is much more than the occasional feelings of sadness that we all have from time to time. A person who experiences most or all of the symptoms listed below for more than two weeks can find it extremely difficult to face even the slightest bump in normal day-to-day activities.

Depression is a condition characterized by:

extreme feelings of sadness

lack of interest or pleasure in most or all activities

significant weight gain or loss

sleeping too little or too much

restlessness or exhaustion

low energy

feeling worthless

difficulty concentrating, and

thoughts of suicide

Note: Only a qualified mental health professional can make use of these symptoms to diagnose depression in your child.

We've also advocated that schools take a greater role in identifying children with LD who may be depressed and developing ways to help them. Children spend more time in school than in most structured environments outside the home, and have their most consistent and extensive contact with teachers. Furthermore, children's behaviors, their interactions with others, and academic performance — all important indicators of mood and the ability to cope — are easily observed in school. Therefore, it is not unusual for educators to be the first people to notice problems developing.

However, as a parent, you need to stay in regular contact with your child's school and ask several important questions:

Is my child making academic progress, performing about the same, or doing worse?

Is my child interacting positively with others or is he withdrawing?

Does my child appear to be happy during school or sad?

Does my child appear tired or seem to have adequate energy?

Does my child seem to have a positive or negative attitude toward school?

A combination of answers to these questions that he is doing worse academically, withdrawn, sad, tired, and has a negative attitude are red flags that you should consider having your child evaluated for depression by a licensed clinician.

Remember, schools will not typically contact you when your child is having trouble in these areas. This is because children with depression do not usually engage in the acting out behaviors that would place them in conflict with the school. You need to be proactive and persistent to get this information from schools — even if your child is receiving special education services.

What to do if your child with LD seems depressed

Clearly, children with LD can and do experience depression. There are several things we can do to help them. The most important thing is to become familiar with the symptoms of depression and get your child in to see a psychiatrist or psychologist if you suspect problems are developing.

Once a diagnosis of depression has been made, there are several treatment options. The best option is usually a combination of medication and psychotherapy. You should also work in conjunction with your child's school for two reasons:

Teachers can play an important role in identifying (but not diagnosing) children who may be depressed.

If your insurance does not cover psychotherapy services or you cannot afford them and your child is receiving special education under the federal category of learning disability, he may be entitled to counseling as a related service under the Individuals with Disabilities Education Act (IDEA).

There is no reason for any child to suffer from depression when effective treatments are available. Through your efforts, and in conjunction with the school, your child can receive the treatment he needs and deserves.